The asymptomatic patient with suspected myocardial contusion

Blunt Cardiac Injury: Case Report of Salvaged Traumatic Right Atrial Rupture

“…Of those patients who experience rupture of a cardiac chamber, only a small fraction reaches the emergency room alive. [9][10][11][12][13][14][15][16] Initial evaluation of the patients at risk for blunt cardiac injury should include an appropriate history and physical exam, combined with obtaining a chest radiograph and a 12-lead Electrocardiogram. A 24-hour period of observation, which includes electrocardiogram telemetry, should be employed if the patient suspected to have blunt cardiac injury is hemodynamically stable and has one of the following: an abnormal electrocardiogram, an age greater than 55 years or history of cardiac disease.…”

“…There is no clear evidence about the role of cardiac enzymes in patients with blunt cardiac injury. [14,19] Electrocardiogram changes that correspond to clinically significant blunt cardiac injury are usually present at the time of admission. These changes; however, are occasionally detected after admission, but usually within the first 24 hours after injury.…”

“…The findings are usually nonspecific, since similar changes occur in the setting of several metabolic abnormalities associated with significant trauma, such as hypoxia, hypovolemia, acidosis, and electrolyte imbalances. [13][14][15][16][17][18] Multiple studies have shown that cardiac enzymes lack the specificity for the risk of developing complications secondary to blunt cardiac injury. More recently, cardiac Troponin I (cTnI) and cardiac Troponin T (cTnT) have been used to screen for blunt cardiac injury.…”

Challenges in the diagnosis of blunt cardiac injuries

“…As shown in Fig. 2, in young haemodynamically stable patient, a normal ECG precludes the need for further evaluation to detect BCI [14,20,25,38]. However, a small number of patients with a normal ECG can encounter cardiac complications related to BCI [38].…”

“…Cardiac troponins are most specifi c amongst conventional markers as they differ from the skeletal isoform by a unique aminoterminal sequence of 31 amino acids never expressed by skeletal muscle [43]. Cardiac troponin-I has shown maximum sensitivity (23-100%) and specifi city (85-97%) in detecting clinically signifi cant BCI [34][35][36][37][38][39][40][41][42][43][44][45][46]. Velmahos et al [47] concluded that, 100% negative predictive value was reached on combining ECG with troponin-I at 8 hours.…”